目的 探讨分叶指背五边形皮瓣应用于并指分指术的近期疗效.方法 对2018年1月至2019年10月温州医科大学附属第二医院育英儿童医院手外整形科应用分叶指背五边形皮瓣手术治疗的单侧单纯皮肤并指患儿15例临床资料进行回顾性分析.记录术后皮瓣坏死和创口感染等早期并发症发生情况;采用指蹼爬移Withey评分和瘢痕温哥华评分对患指术后外观进行评价;记录因手术并发症而需行再次手术情况;测量指蹼深度并与健侧进行比较;利用调查问卷评估患儿家长对术后效果满意度.结果 15例患儿均获随访,平均随访时间14(12～20)个月.全部皮瓣均一期成活,术后未见皮瓣坏死和感染等并发症.无患儿因指蹼爬移或屈指挛缩需行再次手术.术后指蹼外形宽大,患侧指蹼深度与健侧差异无统计学意义.患儿家长对手术效果满意.结论 应用分叶指背五边形皮瓣手术治疗并指畸形,可避免指蹼和指体掌侧线性瘢痕的形成,减少指蹼爬移和屈指挛缩的发生,近期疗效令人满意.

Objective In this study,a new surgical technique was developed to reconstruct the lateral nail fold in the duplicated thumbs with a common nail and postoperative outcomes were evaluated.Methods From December 2012 to October 2015,sixteen duplicated thumbs with a common nail were treated in our hospital using a flap from resected finger pulp which did not include the nail and phalanx.Unilateral inverting suture was performed between the flap and nail bed to reconstruct the lateral nail fold and nail groove.Postoperative outcomes were evaluated by Wang-Gao scoring system (total 12).Results The follow-up period ranged from 10 to 45 months.The reconstructed nails were smooth and had a natural lunula,and the nail width was about 80％-100％ of their normal sides.There was a right angle between the nail epithelium and lateral nail fold in four cases,and an acute angle in two cases.The reconstructed nails were asymmetrical in these thumbs.One patient showed a hypertrophy in the lateral nail fold.The reconstructed nails were evaluated by Wang-Gao scoring system:10 in 2 cases,11 in 4 and 12 in 10.All the cases had excellent results.Conclusions The nail width usually is more than 80％ of the normal sides in the radial polydactyly with a common nail.The surgical technique can reconstruct a natural lateral nail fold and nail groove,and avoid the nail deformity caused by the Bilhaut-Cloquet procedure.

BACKGROUND:Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow-through blood supply, compared with that of a flap with a flow-end blood supply and perforator terminal branch.METHODS:Forty Sprague-Dawley rats, 20 in each group, were assigned to transfer of a superficial epigastric artery pedicle island flap with a flow-through or flow-end configuration of blood supply. Laser Doppler imaging was used to evaluate flap perfusion 2 h, 3 days and 5 days after surgery. The rats were killed on day 5, and lead oxide-gelatine-enhanced flap angiography and histology with haematoxylin and eosin staining was performed. Dorsal midline tissue was excised for quantification of vascular endothelial growth factor by western blot assay.RESULTS:On day 5 after surgery, the flow-through group exhibited a significantly greater mean(s.d.) flap survival area (97·8(3·5) versus 80·8(10·2) per cent; P = 0·003), microvascular density (303(19) versus 207(41) per mm(2) ; P < 0·001) and perfusion (8·64(0·14) versus 5·95(0·14) perfusion units; P < 0·001) than the flow-end group. The flow-through group exhibited more angiosomes connected by dilated vascular anastomoses between the skin and subcutaneous fasciae.CONCLUSION:The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.

OBJECTIVETo investigate the effectiveness of dorsal pentagonal flap for reconstruction of the web space in congenital toe syndactyly.METHODSBetween January 2009 and June 2014, 10 patients with congenital toe syndactyly were treated for web space reconstruction with dorsal pentagonal flap. There were 6 boys and 4 girls with the average age of 42 months (range, 8 months to 9 years). The congenital toe syndactyly located at the left foot in 5 cases, the right foot in 4 cases, and both feet in 1 case; 7 patients had polydactyly and 1 patient had brachydactylia. During follow-up, the toe function and web space appearance, web space depth, and web space gradient were observed to evaluate the effectiveness.RESULTSAll 13 flaps survived and incisions healed by first intention. Ten patients were followed up 6-50 months (mean, 26 months). The skin color and texture in 13 reconstructed web spaces were close to normal web space. in 9 patients undergoing web spaces reconstruction of single foot, the abduction angle of toes was (42.879±3.703) at the injured side, showing no significant difference when compared with the normal side [(45.922±2.657)°] (t= -2.004, P=0.062); the web space depth was (1.881±0.266) cm at the injured side and was (1.631±0.202) cm at the normal side, showing significant difference (t=2.248, P=0.039); and the web space gradient was (42.733±3.421)° at the injured side and was (41.189±5.593)° at the normal side, showing no significant difference (t=0.707, P=0.490). The web space appearance, web space depth, and web space gradient were close to those of the normal web space in 1 patient undergoing bilateral web spaces reconstruction.CONCLUSIONWeb space reconstruction with dorsal pentagonal flap is easy to perform with reliable blood supply and low re-operated rate. The cosmetic and functional results are satisfactory.

Objective To investigate and evaluate the results of covering soft tissue defect on the middle and distal segments of the fingers using digital artery dorsal branch flap.Methods From May 2010 to October 2011,18 cases 19 fingers with soft tissue defects were treated with transferring the digital artery dorsal branch flap.The flap size ranged from 2.0 cm× 3.0 cm to 2.5 cm× 4.5 cm cm.The defect at the donor site was covered with full-thickness skin graft from the forearm.Results Sixteen flaps of 19 fingers survived.Partial necrosis occurred in 3 flaps.All the skin grafts at the donor sites survived.Fifteen cases of 15 fingers were follow-up for 6 to 12 months.The color,texture and contour of the flaps were good.Two-point discrimination was 8 to 10 mm.No obvious functional problem was found in PIP and DIP joint motion.Conclusion The digital artery dorsal branch flap is a good option for coverage of soft tissue defect of the finger.Familiarization with the anatomy and careful handling of the pivot point of the flap are key to ensuring survival of the flap and gaining good aesthetic and functional outcomes.